Mauch J, Renner N, Rikli D
Chirurgische Klinik, Abteilung Traumatologie, Kantonsspital Aarau.
Swiss Surg. 2000;6(6):299-303. doi: 10.1024/1023-9332.6.6.299.
Interlocking intramedullary nailing has become the preferred method of internal fixation for diaphyseal fractures of the lower extremity. In shaft fractures of the humerus however open reduction and internal fixation with plates and screws is still considered the gold standard for operative treatment. The unreamed humerus nail (UHN) is a new implant for interlocking intramedullary nailing, which allows for stable fixation of humerus shaft fractures and immediate functional after treatment. The UHN could thus become an equal alternative to plate osteosynthesis. From this point of view we analyzed retrospectively 19 shaft fractures of the humerus, which have been treated at our institution with an UHN. Infections and iatrogenic nerve lesions did not occur. One patient with a rotational malalignment of 45 degrees underwent a secondary procedure. In two out of ten fresh fractures the bone healing failed and resulted in a non-union. In all cases of pathological fractures a good palliation could be achieved. With exception of two patients the range of motion of the shoulder and elbow was symmetric. We conclude that the UHN is a real alternative to plate osteosynthesis. Compared with most series of plate osteosynthesis published in the literature the risk for iatrogenic lesions of the radial nerve appears to be lower. Even in this small series we found however a rather high rate of non-unions.
交锁髓内钉已成为治疗下肢骨干骨折的首选内固定方法。然而，对于肱骨干骨折，切开复位钢板螺钉内固定仍被认为是手术治疗的金标准。非扩髓肱骨髓内钉（UHN）是一种用于交锁髓内钉的新型植入物，它能实现肱骨干骨折的稳定固定，并在术后立即恢复功能。因此，UHN可能成为钢板接骨术的等效替代方法。从这一角度出发，我们回顾性分析了在我院采用UHN治疗的19例肱骨干骨折。未发生感染和医源性神经损伤。1例出现45度旋转畸形的患者接受了二次手术。10例新鲜骨折中有2例骨折愈合失败，导致骨不连。在所有病理性骨折病例中，均实现了良好的减状治疗。除2例患者外，肩、肘关节活动范围对称。我们得出结论，UHN是钢板接骨术的一种切实可行的替代方法。与文献中发表的大多数钢板接骨术系列研究相比，桡神经医源性损伤的风险似乎更低。然而，即使在这个小样本系列研究中，我们也发现骨不连发生率相当高。
